Intsebenziswano yokuSebenza kwiLaparoscopic iyonke yeGastrectomy

Intsebenziswano yokuSebenza kwiLaparoscopic iyonke yeGastrectomy

I-Abstract, Injongo: Ukuxoxa ngentsebenziswano yokusebenza kunye namava okonga kwi-laparoscopic total gastrectomy.Iindlela Idatha yeklinikhi yezigulane ze-11 eziye zafumana i-laparoscopic iyonke i-gastrectomy yahlaziywa ngokuphindaphindiweyo.Iziphumo Izigulana ezilishumi elinanye ezaye zenziwa i-laparoscopic total gastrectomy zaye zakhutshwa ngaphandle kweengxaki ezimandundu.
Isiphelo: I-Laparoscopic iyonke i-gastrectomy ine-trauma encinci, ukukhupha ngokukhawuleza, intlungu encinci kunye nokubuyisela ngokukhawuleza emva kokuhlinzwa kwizigulane.Ifanelekile isicelo seklinikhi.
Amagama angundoqo laparoscopy;i-gastrectomy epheleleyo;intsebenziswano yokusebenza;ukusika i-laparoscopic kufutshane
Ngokunzulu kweengqikelelo zanamhlanje zotyando oluncinci, itekhnoloji ye-laparoscopic isetyenziswa ngokubanzi kuqheliselo lwezonyango.Utyando lwe-Laparoscopic luneenzuzo zokuphulukana negazi elingaphantsi kwe-intraoperative, iintlungu ezingaphantsi kokuhlinzwa, ukubuyiswa ngokukhawuleza komsebenzi wesisu, ukuhlala esibhedlele okufutshane, isilonda esincinci sesisu, impembelelo encinci ekusebenzeni komzimba, kunye neengxaki ezimbalwa [1].Kwiminyaka yakutshanje, ngokuphuculwa okuqhubekayo kweteknoloji ye-laparoscopic, izigulane ezininzi ezinomhlaza wesisu ziphathwa ngotyando lwe-laparoscopic.I-Laparoscopic total gastrectomy inzima ukusebenza kwaye idinga inqanaba eliphezulu lobugcisa, kwaye idinga intsebenziswano esondeleyo phakathi kogqirha kunye nomongikazi kwigumbi lokusebenza ukuze kuqinisekiswe ukugqitywa komsebenzi.Izigulane ezilishumi elinanye eziye zafumana i-laparoscopy epheleleyo ye-gastrectomy kwisibhedlele sethu ukususela ngo-Matshi 2014 ukuya kuFebruwari 2015 zakhethwa ukuba zihlalutye, kwaye intsebenziswano yobuhlengikazi ichazwe ngolu hlobo lulandelayo.
1 Izinto kunye neendlela
1.1 Ulwazi ngokubanzi Izigulane ezilishumi elinanye eziye zafumana i-laparoscopy epheleleyo ye-gastrectomy kwisibhedlele sethu ukususela ngo-Matshi 2014 ukuya kuFebruwari 2015, kubandakanywa amadoda angama-7 kunye nabasetyhini aba-4, abaneminyaka eyi-41-75 iminyaka, kunye nomyinge weminyaka eyi-55.7.Umhlaza wesisu waqinisekiswa yi-gastroscopy kunye ne-pathological biopsy ngaphambi kokusebenza kuzo zonke izigulane, kwaye isigaba seklinikhi sangaphambili sasiyisigaba I;kwakukho imbali yotyando lwesisu esiphezulu okanye utyando olukhulu lwesisu kwixesha elidlulileyo.
1.2 Indlela yotyando Zonke izigulane zenze i-laparoscopic radical total gastrectomy.Zonke izigulane zaphathwa nge-anesthesia jikelele kunye ne-tracheal intubation.Ngaphantsi kwe-pneumoperitoneum, i-omentum kunye ne-omentum yachithwa nge-scalpel ye-ultrasonic kunye ne-Ligasure ukukhupha imithambo yegazi ye-perigastric, kunye ne-lymph nodes ejikeleze umthambo wesisu osekhohlo, i-hepatic artery, kunye ne-splenic artery yahlanjululwa.Isisu kunye ne-duodenum, isisu kunye ne-cardia zahlulwa nge-laparoscopic yokusika kunye nesixhobo sokuvala, ukuze isisu sonke sikhululeke ngokupheleleyo.Ijejunam yanyuswa kufutshane nommizo, kwaza kwavuleka indawo encinci kummizo kunye nejejunum, kwaye i-anastomosis ye-esophagus-jejunum side anastomosis yenziwa nge-laparoscopy yokusika kunye nesixhobo sokuvala, kunye nokuvuleka kommizo kunye nejejunum. ngesixhobo sokusika kunye nokuvala i-laparoscopic.Ngokufanayo, isiphelo samahhala se-jejunum sifakwe kwi-jejunum 40cm kude ne-suspensory ligament ye-duodenum.I-5cm yokusikwa kwenziwe phakathi komlomo ongezantsi wenkqubo ye-xiphoid kunye nentambo ye-umbilical ukususa umzimba wesisu.Umzimba wesisu kunye ne-lymph node isampuli zaye zahlaziywa kwaye zathunyelwa kuvavanyo lwe-pathological.Umngxunya we-peritoneal wagungxulwa nge-fluorouracil saline, kwaye ityhubhu yokukhupha amanzi yafakwa ukuvala umngxuma wesisu [2].I-trocar yasuswa kwaye i-poke nganye yaxutywa.
1.3 Utyelelo lwangaphambi kotyando Ndwendwela isigulane kwiwadi ngosuku olu-1 phambi kotyando ukuze uqonde imeko yesigulane ngokubanzi, uphonononge imeko, kwaye ujonge iziphumo zeemvavanyo ezahlukeneyo zaselabhoratri.Thatha inxaxheba kwingxoxo yangaphambi kokusebenza kwisebe ukuba kuyimfuneko, kwaye wenze amalungiselelo apheleleyo okusebenza ngosuku lwesibini.I-Laparoscopic gastric cancer resection iseyindlela entsha yonyango ngokwentelekiso, kwaye uninzi lwezigulana azinalwazi lwaneleyo malunga nalo kwaye luyathandabuza ngalo ukusa kumlinganiselo othile.Ngenxa yokungaqondi, baya kuba nexhala malunga nefuthe lokunyanga kunye nokhuseleko lomsebenzi, kwaye kuya kubakho iingxaki zengqondo ezifana novalo, ukuxhalaba, ukwesaba kunye nokungafuni ukwenza utyando.Ngaphambi kokuhlinzwa, ukuze kupheliswe ukuxhalaba kwesigulane kunye nokusebenzisana kakuhle nonyango, kuyimfuneko ukuchaza ukhuseleko kunye nokusebenza kakuhle kolu tyando kwisigulane, kwaye usebenzise ukuhlinzwa okuyimpumelelo njengomzekelo wokuphucula imvakalelo yokhuseleko kunye nesigulane. ukuzithemba ngonyango.Vumela izigulane zigcine isimo sengqondo esikhululekile kwaye sakhe ukuzithemba ekulweni nesifo.
1.4 Ukulungiswa kwezixhobo kunye nezinto: Usuku olu-1 ngaphambi kokuhlinzwa, khangela kunye nogqirha wotyando ukuba kukho naziphi na iimfuno ezikhethekileyo zesixhobo sotyando, ukuba kukho naluphi na utshintsho kumanyathelo okusebenza kwesiqhelo, kwaye wenze amalungiselelo ahambelanayo kwangaphambili.Lungiselela rhoqo izixhobo zotyando ze-laparoscopic kwaye ujonge isimo se-disinfection, kwaye ukhangele ukuba i-scalpel ye-ultrasonic, i-monitor, umthombo wokukhanya, umthombo we-pneumoperitoneum kunye nezinye izixhobo ziphelele kwaye kulula ukuyisebenzisa.Lungiselela kwaye ugqibelele iintlobo ezahlukeneyo zei-laparoscopic cut closerskwayestaplers tubular.Njengazo zonke ezinye iinkqubo ze-laparoscopic, i-laparoscopic total gastrectomy nayo ijongene nengxaki yokuguqulwa kwi-laparotomy, ngoko ke izixhobo ze-laparotomy kufuneka zilungiswe rhoqo.Ukuze ungachaphazeli ukuqhubela phambili komsebenzi ngenxa yokungalungiswa ngokwaneleyo ngexesha lokusebenza, okanye nokuba yingozi kwimpilo yesigulane.
1.5 Sebenzisana nesigulane ngexesha lotyando kwaye useke ukufikelela kwi-venous emva kokujonga ulwazi lwesazisi luchanekile.Emva kokuncedisa i-anesthetist ukuba enze i-anesthesia, beka isigulane kwindawo efanelekileyo kwaye uyilungise, ubeke i-catheter ye-urinary, kwaye ulungise ngokufanelekileyo ityhubhu yokunciphisa isisu.Abahlengikazi besixhobo bahlamba izandla zabo kwimizuzu engama-20 kwangaphambili, kwaye babale izixhobo, iinaliti kunye nezinye izinto kunye nabongikazi abajikelezayo.Ncedisa ugqirha wotyando ukuba abulale iintsholongwane kwisigulana, kwaye usebenzise umkhono okhuselayo okhuselayo ukwahlula umgca welensi, umgca womthombo wokukhanya, kunye nomgca wemela ye-ultrasonic [3].Khangela ukuba inaliti ye-pneumoperitoneum kunye nentloko ye-aspirator ayithintekiyo, lungisa ummese we-ultrasonic;ncedisa ugqirha ukuba aseke i-pneumoperitoneum, adlulise ukuhlolwa kwe-trocar laparoscopic ukuqinisekisa i-tumor, ukuhambisa izixhobo kunye nezinto ezifunekayo ekusebenzeni ngexesha, kwaye uncedise ugqirha ukuba ahlambulule i-cavity yesisu ngexesha lotyando Umsi wangaphakathi uqinisekisa indawo ecacileyo yotyando.Ngexesha lokusebenza, iindlela ze-aseptic kunye ne-tumor-free kufuneka ziphunyezwe ngokungqongqo.Ukufakwa kwe-cartridge ye-staple ngokwenene kunokwethenjelwa xa kudlula i-laparoscopic cutting kufuphi, kwaye inokudluliselwa kumqhubi kuphela emva kokuba imodeli iqinisekisiwe.Vala isisu kwaye ujonge izixhobo zotyando, i-gauze, kunye neenaliti ze-suture kwakhona.
Iziphumo ezi-2
Akukho namnye kwizigulane ze-11 eziye zaguqulwa kwi-laparotomy, kwaye yonke imisebenzi yagqitywa phantsi kwe-laparoscopy epheleleyo.Zonke izigulane zathunyelwa uviwo lwe-pathological, kwaye iziphumo zibonise ukuba i-postoperative TNM staging ye-tumor eyingozi yayiyisigaba I. Ixesha lokusebenza laliyi-3.0 ~ 4.5h, ixesha eliqhelekileyo laliyi-3.8h;ukulahleka kwegazi ngexesha lokusebenza kwakuyi-100 ~ 220ml, ukulahleka kwegazi okuqhelekileyo kwakuyi-160ml, kwaye kwakungekho gazi.Zonke izigulana zachacha kakuhle kwaye zakhutshwa esibhedlele kwiintsuku ezi-3 ukuya kwezi-5 emva kotyando.Zonke izigulana zazingenazo iingxaki ezifana nokuvuza kwe-anastomotic, ukusuleleka kwisisu, ukusuleleka kwintsholongwane, kunye nokopha kwesisu, kwaye umphumo wotyando wawusanelisayo.
3 Ingxubusho
Umhlaza wesisu lelinye lawona mathumba ayingozi axhaphakileyo kwilizwe lam.Izehlo zayo zinokunxulumana nezinto ezifana nokutya, okusingqongileyo, umoya okanye ufuzo.Inokuthi yenzeke kuyo nayiphi na indawo yesisu, isoyike kakhulu impilo yomzimba kunye nengqondo kunye nokhuseleko lobomi lwezigulane.Okwangoku, olona nyango lusebenzayo lweklinikhi Indlela isasebenza ngoqhaqho, kodwa umonzakalo wotyando wesintu mkhulu, kwaye ezinye izigulana ezisele zikhulile okanye ezo zikwimeko embi ngokwasemzimbeni ziphulukana nethuba lonyango lotyando ngenxa yokunganyamezeli [4].Kwiminyaka yakutshanje, ngophuhliso oluqhubekayo, ukuphuculwa kunye nokusetyenziswa kweteknoloji ye-laparoscopic kumsebenzi wekliniki, izibonakaliso zokuhlinzwa ziye zandiswa ngakumbi.Izifundo zasekhaya nezangaphandle ziye zangqina ukuba utyando lwesisu luneenzuzo ezingaphezulu kunotyando lwemveli kunyango lomhlaza wesisu ophucukileyo.Kodwa ikwabeka phambili iimfuno eziphezulu zentsebenziswano phakathi kogqirha wotyando kunye nomongikazi kwigumbi lokusebenza.Ngelo xesha, abahlengikazi kwigumbi lokusebenza kufuneka benze umsebenzi omhle ekutyeleleni kwangaphambili kwaye banxibelelane nezigulane ukuze baqonde imeko yengqondo yesigulane kunye nesimo somzimba.Ukuphucula amalungiselelo ezinto zotyando kunye negumbi lokusebenza ngaphambi kokusebenza, ukwenzela ukuba izinto zibekwe ngendlela ehlelekile, efanelekileyo kunye nexesha elifanelekileyo;ngexesha lokusebenza, qwalasela ngokusondeleyo ukukhutshwa komchamo wesigulane, umthamo wokuphuma kwegazi, iimpawu ezibalulekileyo kunye nezinye izibonakaliso;Ukuqikelela inkqubo yokusebenza kwangaphambili, ukuhambisa izixhobo zotyando kwangexesha kwaye ngokuchanekileyo, lawula imigaqo, ukusetyenziswa kunye nokugcinwa okulula kwezixhobo ezahlukeneyo ze-endoscopic, kunye nokuqinisekisa inkqubela phambili egudileyo yotyando ngowona mlinganiselo mkhulu.Ukusebenza okungqongqo kwe-aseptic, intsebenziswano enyanisekileyo kunye nokusebenza okusebenzayo zizitshixo zokuqinisekisa ukuphunyezwa komsebenzi.
Ukushwankathela, i-laparoscopic iyonke i-gastrectomy ine-trauma encinci, ukukhupha ngokukhawuleza, intlungu encinci kunye nokubuyisela ngokukhawuleza emva kokuhlinzwa kwizigulane.Ifanelekile isicelo seklinikhi.

iimbekiselo
[1] Wang Tao, Ingoma Feng, Yin Caixia.Intsebenziswano yabongikazi kwi-laparoscopic gastrectomy.I-Chinese Journal of Nursing, i-2004, i-10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al.Ukusetyenziswa kweLigaSure kwi-laparoscopic yotyando lwesisu.Ijenali yaseTshayina ye-Minimally Invasive Surgery, i-2004, i-4 (6): 493-494.
[3] Xu Min, Deng Zhihong.Intsebenziswano yotyando kwi-laparoscopic incedise i-distal gastrectomy.Ijenali yoQeqesho lwabahlengikazi, i-2010, i-25 (20): i-1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al.Ingxelo malunga neemeko ze-150 ze-laparoscopic epheleleyo ye-D2 ye-radical gastrectomy yomhlaza wesisu.Ijenali yaseTshayina ye-Endoscopic Surgery (uHlelo lwe-Electronic), i-2012, i-5 (4): 36-39.

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